from Little and fallace 2013 edition, bringing brief points about "How to manage patients with diabetes mellitus in dental office?"

1. DIABETES MELLITUS
CONSIDERATIONS IN DENTAL OFFICE
Presentedby:M.R.Vatankhah

2. Intro.

3. Imp. Medical features
■ Diagnostic criteria for diabetes mellitus:
– FPG 8hrs. > 126 mg/dL
– S&S + random blood glucose ≥ 200 mg/dL
– 2hrs. Post-load blood glucose ≥ 200 mg/dL
– A1C assay ≥ 6.5 %

4. Imp. Medical features
A1CPostprandial P GPremeal P G*
4-6%<140<100 (mean = 90)Normal
<7%<18090 – 130ADA targets

5. Type-1 medications

6. Non-insulin medications

7. Non-insulin medications

9. Insulin reaction

10. History

11. Aims
■ Final aim: correcting both oral infection & plasma glucose level.
■ Major goal: not occurring insulin shock

12. Analgesics
■ Avoid use of aspirin and other NSAIDs in patients taking sulfonylureas
because they can worsen hypoglycemia.

13. Antibiotics
■ Prophylactic antibiotics generally are not required.
■ Brittle diabetes for whom an invasive procedure is required
■ Oral health is poor + FPS > 200 = I&D , Ext. , pulpotomy, ABTherapy

14. Anesthesia
■ No issues if diabetes is well controlled.
■ MI, cardiac arrhythmia : <2 cartridges containing 1:100.000 epi.
(MET<4)
■ No need for extra anxiety and allergy control.

15. BP & bleeding & CVD
■ Diabetes is associated with hypertension.
■ Thrombocytopenia is a rare adverse effect associated with sulfonylureas.
(bleeding control)
■ Beta-blocker drugs can exacerbate hypoglycemia in patients taking
sulfonylureas.

16. Diabetes and Acute Oral Infections

17. Oral Manifestations.
Diabetesoral
manifestations
Xerostemia
Poor healing
PA abscesses
Increase in caries
incidence
Bacterial &
Gingivitis &
periodontitis